'HIT' guides coaches in assessing athlete injuries

By Melinda L. Flegel

Flawlessly executing a difficult mount is only the beginning of a balance beam routine, just as the emergency action steps is only the start of sport first aid assessment and care. Both are pivotal skills but only a small portion of an entire routine. Beam specialists and sport first aiders alike must also be able to perform more common and basic but equally important skills. For a gymnast, these may be turns and jumps on the beam. For the sport first aider, these skills include conducting a physical assessment and corresponding first aid techniques.

After completing the emergency action steps and establishing the ABCs, you should begin the physical assessment to pinpoint the nature, site, and severity of an injury or illness. Do not begin the physical assessment until the ABCs have been established. As with the emergency action steps, follow a standard pattern, such as the following, to make the evaluation more thorough. The HIT acronym will help you remember these steps:

H—History

I—Inspection

T—Touch

History

In the physical assessment, the “history” step is a time to gather additional information about how the injury or illness happened. Your goal is to determine the location, mechanism, symptoms, and previous occurrences.

In taking an injury history, follow these steps:

1. Recall what you saw and heard.

2. Talk to the injured athlete—listen for symptoms that describe how the athlete is feeling, such as numb, pain, grating sensation, or cold.

3. Talk to other athletes, coaches, officials, or bystanders (if they witnessed the injury and if the athlete can’t recall what happened).

4. Check the athlete’s medical history card.

If the athlete is suffering from an injury, find out the following:

• What caused the injury (e.g., direct contact with another player, object, or the ground; or a twisting or turning motion)?

• Did the athlete hear a pop, crack, or other noise when the injury occurred?

• Where does it hurt?

• Did the athlete feel any unusual symptoms when the injury happened (e.g., pain, numbness, tingling, weakness, grating, or a snapping feeling)?

• Has the athlete suffered this injury before?

If the athlete is suffering from a sudden illness, find out the following:

• What symptoms the athlete is experiencing, such as nausea, dizziness, shortness of breath, and so on

• If the athlete is suffering from a chronic illness (e.g., diabetes, epilepsy, asthma, or allergies)

• Whether the athlete takes any medications for the illness

• What, if anything, seemed to bring on the illness (e.g., a bee sting, exposure to dust, or spoiled food)

The information that you gather during the history step will help guide your next step, which is the inspection.

Inspection

Use the information from the injury history to pinpoint where you should look for obvious signs (actual physical manifestations) of an injury or illness. For example, if an athlete reports hearing and feeling a pop in the ankle, you’ll want to look for signs of an ankle injury such as a deformity or swelling. The following are other obvious signs that you should check for:

• Bleeding—Is it profuse or slow? Dark red or bright red?

• Skin appearance—Is the skin pale or flushed? Dry or sweaty? Is it blue or gray?

• Pupils—Compare the two pupils. Are they dilated (enlarged), constricted (small), or uneven in size? Also, use the penlight from your sport first aid kit to check whether each pupil reacts to light by constricting (figure 5.1). If the pupils are uneven or do not react to light, the athlete may be suffering from a head injury.

• Deformities—Do you see any indentations or bumps? If the deformity is on one side of the body, always compare it to the opposite side.

• Signs of sudden illness—Vomiting or coughing.

• Swelling—Is there any puffiness around the injured area or other areas?

• Discoloration—Is there any bruising or other marks?

• Ability to walk—Does the athlete limp or is the athlete totally unable to bear weight?

• Position of an upper extremity (arm, elbow, forearm, wrist, or hand)—Is the athlete supporting the forearm with the other hand or is the arm held in an unusual position, such as out to the side?

For some illnesses and injuries, it’s helpful to check the athlete’s pulse (heart) rate. This can be done at either the wrist (radial pulse, figure 5.2) or neck (carotid pulse, figure 5.3). Always use your fingers to check the pulse because your thumb has its own pulse. The carotid pulse is easier to feel than the radial; however, be careful not to push too hard, or you may reduce blood flow to the athlete’s brain. When taking the pulse, try to determine the rate, regularity, and strength of the heartbeat.

If the athlete has been active, pulse rate will be faster than the resting pulse rate. Table 5.1 provides normal resting heart rate per minute for various ages. If pulse rate doesn’t return to resting levels within a few minutes, or if the rate feels irregular, you should suspect a potentially life-threatening injury or illness and send for emergency medical assistance.

The information gathered during the inspection should help to further pinpoint the exact nature of an illness or injury. This information, combined with what is learned in the history and in the “touch” portion of the assessment, which is performed next, will determine the first aid that you will provide.

Touch

Sometimes, looks can be deceiving. What appears to be an intact, fully functioning body part may in fact have severe internal damage. So, to get a better idea of the nature of the injury, gently touch the injured area with your fingertips. Start away from the injury, for example, start at the fingers and wrist if the hand is injured, and work your way toward the injury. Check for the following:

• Point tenderness—Is there an area that is extremely painful?

• Skin temperature—Is it hot? Cool? Sweaty? Dry?

• Sensation—Can the athlete feel you touching the area?

• Deformity—Can you feel any bumps or indentations that you did not see in the inspection?

Again, if one side of the body is injured (such as the ribs, arm, or leg), always compare it to the opposite side. After completing the physical assessment plan of history, inspection, and touch, you will be better able to focus your first aid techniques on the specific injury or illness that is affecting an athlete.

Take some time to review the procedures of the physical assessment, shown in figure 5.4.

Remember to continue to monitor the ABCs even after beginning to administer first aid to the site of the injury. You must continually observe the ABCs of any seriously injured athlete, even though the athlete’s airway, breathing, and circulation may initially be normal.

Basic Sport First Aid Techniques

Upon completing the physical assessment, you may find that you have to control external bleeding, minimize systemic tissue damage (shock), splint injuries, and minimize local tissue damage. So let’s discuss these basic first aid techniques, in order of priority.

Controlling Profuse Bleeding

Although not a common injury, profuse bleeding from an artery or vein can be life threatening. Bleeding can also occur internally, from injuries such as bruised muscles, ruptured spleens, and bruised kidneys. Details on bleeding internal organs and how to care for them are explained in chapter 9.

Before administering first aid for bleeding, be sure to protect yourself against exposure to infected blood.

Preventing Blood-Borne Pathogen Transmission

Don’t let a fear of human immunodeficiency virus (HIV), hepatitis B, or other blood-borne pathogens keep you from administering first aid to injured athletes. Learn more about these diseases and how they can be transmitted. Contact your state athletic association for specific sports rules and policies regarding blood-borne pathogens. For example, some sports require athletes to change a bloody uniform before returning to competition.